TY  - BOOK
AU  - Kiguchi, Misaki
TI  - Treatment of superficial and perforator reflux and deep venous stenosis improves healing of chronic venous leg ulcers
PY  - 2020///
KW  - *Catheter Ablation
KW  - *Endovascular Procedures
KW  - *Laser Therapy
KW  - *Saphenous Vein/su [Surgery]
KW  - *Sclerotherapy
KW  - *Varicose Ulcer/th [Therapy]
KW  - *Wound Healing
KW  - Aged
KW  - Catheter Ablation/ae [Adverse Effects]
KW  - Chronic Disease
KW  - Databases, Factual
KW  - Endovascular Procedures/ae [Adverse Effects]
KW  - Endovascular Procedures/is [Instrumentation]
KW  - Female
KW  - Humans
KW  - Laser Therapy/ae [Adverse Effects]
KW  - Male
KW  - Middle Aged
KW  - Recurrence
KW  - Retrospective Studies
KW  - Saphenous Vein/dg [Diagnostic Imaging]
KW  - Saphenous Vein/pp [Physiopathology]
KW  - Sclerotherapy/ae [Adverse Effects]
KW  - Stents
KW  - Time Factors
KW  - Treatment Outcome
KW  - United States
KW  - Varicose Ulcer/dg [Diagnostic Imaging]
KW  - Varicose Ulcer/pp [Physiopathology]
KW  - MedStar Washington Hospital Center
KW  - Surgery/Vascular Surgery
KW  - Journal Article
N2  - CONCLUSIONS: This study demonstrates that correction of superficial truncal vein reflux, as well as deep vein stenosis, both contribute to healing of VLU. Patients who fail to heal their VLU after superficial and perforator ablation should have the iliocaval system imaged to identify hemodynamically significant stenoses or occlusions amenable to stenting, which facilitates venous ulcer healing even in patients with large ulcers. Copyright (c) 2019. Published by Elsevier Inc; METHODS: Multicenter retrospective cohort study using a standardized database to evaluate patients with chronic venous ulcers treated between January 2013 and December 2017; OBJECTIVE: To evaluate the impact of three treatment modalities, superficial truncal vein ablation, perforator vein ablation, and deep venous stenting on venous leg ulcer (VLU) healing, as well as their cumulative effect on ulcer healing, in an attempt to establish the best algorithm for the treatment of chronic and recalcitrant VLUs; RESULTS: Eight-hundred thirty-two consecutive patients with VLU were identified at 11 centers in the United States. All patients were initially managed with wound care and compression for at least 2 months. Compression and wound care management alone, used in 187 patients, led to ulcer healing in 75% of patients by 36 months. Ulcer recurrence in patients managed without surgery at 6, 12, and 24 months was 3%, 5% and 15%, respectively. Five hundred twenty-eight patients underwent ablation of incompetent superficial veins, and 344 of those also underwent incompetent perforator ablation. Patients who underwent truncal vein ablation alone had an ulcer healing rate of 51% at 36 months. Patients who received both superficial and perforator ablation were significantly younger, and had a 17% improvement in healing at 36 months (68% vs 51%, respectively), but there was no impact of combined superficial and perforator ablations on ulcer recurrence rates. One hundred thirty-four patients had stenosis of one of more lower extremity deep veins and 95 (71%) underwent endovenous stenting. Ulcer healing and recurrence rates for those who underwent stent placement alone was 77% and 27%, respectively, at 36 months. Patients who underwent deep venous stenting and ablation of both incompetent truncal and perforator veins had an ulcer healing rate of 87% at 36 months and ulcer recurrence of 26% at 24 months
UR  - https://dx.doi.org/10.1016/j.jvsv.2019.09.016
ER  -